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Shown here are the four drugs in the standard regimen of rst-line drugs. Also shown are the dates these four drugs were discovered—all more than 40
years ago.
Credit: NIAID
Tuberculosis, which results from an infection with Mycobacterium tuberculosis, can be cured with a combination of rst-line
drugs taken daily for several months.
https://www.niaid.nih.gov/diseases-conditions/tbdrugs 1/4
11/11/2019 Tuberculosis Drugs and Mechanisms of Action | NIH: National Institute of Allergy and Infectious Diseases
MDR TB occurs when a Mycobacterium tuberculosis strain is resistant to isoniazid and rifampin, two of the most powerful rst-line drugs. To cure MDR
TB, healthcare providers must turn to a combination of second-line drugs, several of which are shown here. Second-line drugs may have more side
effects, the treatment may last much longer, and the cost may be up to 100 times more than rst-line therapy. MDR TB strains can also grow resistant to
second-line drugs, further complicating treatment.
Credit: NIAID
Bedaquiline and Delamanid are new drugs. Ethambutol, Pyrazinamide, Thioamides, Cycloserine, Para-aminosalicylic acid, Streptomycin, and Clofazimine
are possibly effective. Kanamycin, Capreomycin and Amikacin are injectable second-line.
Credit: NIAID
XDR TB occurs when a Mycobacterium tuberculosis strain is resistant to isoniazid and rifampin, two of the most powerful
rst-line drugs, as well as key drugs of the second line regimen—any uoroquinolone and at least one of the three injectable
drugs shown above. XDR TB strains may also be resistant to additional drugs, greatly complicating therapy.
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11/11/2019 Tuberculosis Drugs and Mechanisms of Action | NIH: National Institute of Allergy and Infectious Diseases
Several new types of TB drugs currently under development are shown here. NIAID has supported the development of ve of these compounds, SQ-109,
PA-824 (Pretomanid), Sutezolid, Linezolid, and Meropenem, which are denoted by asterisks (*) above.
Credit: NIAID
Thioamides, Nitroimidazoles, Ethambutol, and Cycloserine act on cell wall synthesis. Diarylquinoline inhibits ATP synthase. PAS, Fluoroquinolones, Cyclic
Peptides and Aminoglycosides act on the DNA.
Credit: NIAID
Tuberculosis drugs target various aspects of Mycobacterium tuberculosis biology, including inhibition of cell wall synthesis,
protein synthesis, or nucleic acid synthesis. For some drugs, the mechanisms of action have not been fully identi ed.
https://www.niaid.nih.gov/diseases-conditions/tbdrugs 3/4
11/11/2019 Tuberculosis Drugs and Mechanisms of Action | NIH: National Institute of Allergy and Infectious Diseases
Nitroimidazoles, SQ-109,, Meropenem, and Benzothiazinones act on cell wall synthesis. Imidazopyridine Amide inhibits ATP synthesis. Rifamycins,
Oxazolidinones and Macrolides act on DNA.
Credit: NIAID
Tuberculosis drugs target various aspects of Mycobacterium tuberculosis biology, including inhibition of cell wall synthesis,
protein synthesis, or nucleic acid synthesis. For some drugs, the mechanisms of action have not been fully identi ed.
Additional TB Information
Working Group on New TB Drugs (http://wayback.archive-
it.org/7761/20160909192435/http://www.newtbdrugs.org/pipeline.php)
Handbook of Anti-Tuberculosis Agents (http://wayback.archive-
it.org/7761/20160909192435/http://www.tballiance.org/newscenter/research_papers/TB_DB_Final.pdf) pdf (PDF)
2008
TB Alliance (http://wayback.archive-it.org/7761/20160909192435/http://www.tballiance.org/)
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